The relationship between frequency and intensity of fears and a collagen condition

Encouraged by the positive relationship between joint laxity and panic anxiety, our objective in this study was to compare widespread cultural fears in subjects with and without joint hypermobility syndrome and to assess whether this relationship is sustained for common fears as well. A sample consisting of 1,305 subjects from a rural town were assessed for joint hypermobility syndrome using Beighton's criteria. We assessed fear intensity and frequency using a modified version of the Fear Survey Schedule (FSS-III). Intense fears, defined with a score of 3-4, were compared between hypermobile and nonhypermobile subjects. The analysis was carried out separately for men and women. Nonparametric analysis was applied throughout. Joint hypermobility syndrome was found in 19.9% (141) of women and 6.9% (41) of men. Concerning the fear survey, when we compared the groups with and without joint hypermobility, the mean total scores for both genders were significantly higher for the hypermobile group. When we analyzed each item individually, 43 out of the 44 most severe fears in women and 36 out of the 39 in men, scores were significantly higher in the hypermobile group. We found significant differences between subjects with and without joint hypermobility when assessing specific fears, reinforcing the hypothesis that intensity of fears is greater in subjects with joint hypermobility syndrome. These results show that the association of joint laxity and phobic anxiety is sustained for intense fears and might represent a susceptibility factor for these anxiety conditions.

[Relationship between the experience of steroids side effects and noncompliance with oral steroids treatment in collagen disease patients]

PURPOSE

To analyze the relationship between the experience of side effect and the compliance with oral steroids drug treatment of the patients in Collagen Disease Clinic.

METHODS

A questionnaire survey through interview was conducted on 165 outpatients with various collagen disease at Saga Medical School Hospital.

RESULTS

94 patients (57%) had a history of noncompliance to the steroids drug. 49 patients (52.1%) adventitiously had forgotten to take the steroids as ordered and 45 patients (47.9%) intentionally had regulated their steroids dose or had discontinued the steroids drug treatment. Over 80% of the patients had experienced side effects of the steroids. The patients who experienced one or more of the following side effects, osteoporosis, bone fractures, menstrual disorders, moon face, central obesity, alopecia, acnelike eruption, manic-depressive state, and insomnia, intentionally regulated, or discontinued the steroids therapy. In addition, the patients who were not made cognizance about side effects of the steroids by their physicians and nurse tended to noncompliance group.

CONCLUSION

To increase the compliance rate with oral steroids drug treatment, we must make conscious efforts to inform the patients on the condition of their medical states, the efficacy of the prescribed drugs, and the side effects and risk concerning discontinuation of the steroids. It is Also necessary to establish "Drug information and counseling day" in outpatient Department.

[Relationship between autoimmune diseases and personality traits in women]

The personality traits of 40 women with non organ-specific dysimmune diseases were studied by means of a questionnaire devised to evaluate behavioural components including 48 items divided into 8 different patterns. The patients fell into 3 groups. Group I comprised 20 women with collagen diseases, including systemic lupus erythematosus (n = 8), scleroderma (n = 4), Sharp's syndrome (n = 4), polymyositis (n = 3) and Shulman's syndrome (n = 1). Group II was made of 10 women with either primary (n = 6) or secondary (n = 4) Sjögren's syndrome. Group III consisted of 10 women with vasculitis. Results were compared with those obtained in a control population of 41 women without dysimmune disease. At the time of examination the mean daily dose of prednisone was 10.5 mg. All 40 patients differed from the control group by their unobtrusiveness, self depreciation (P less than 0.01), hyperconformability and excessive kindness (P less than 0.02). Additional traits were a tendency towards contradiction and intolerance in patients with Sjögren's syndrome and a lack of agressiveness combined with a feeling of inferiority in patients with vasculitis. These results confirms that patients with dysimmune disease are psychologically fragile and suggest that the possibility of psychotherapy should be examined in these patients.

The Illness Behavior Assessment Schedule: reliability and validity

A patient's illness behavior represents an important component of any clinical presentation, and may in itself be pathological. Illness behavior and abnormal illness behavior are not easily evaluated, and considerable disagreement exists as to the criteria for making diagnoses such as "conversion reaction," "hypochondriacal reaction," etc. This paper describes the background, reliability and validity of the Illness Behavior Assessment Schedule (IBAS) which has been developed as a basis for a systematic and standardized approach to illness behavior.

The medical care of psychiatric patients

Longitudinal and cross-sectional data have demonstrated a high incidence of physical illness among psychiatric patient populations. Problems involved in the treatment of medically ill psychiatric patients include the nonspecificity of psychiatric symptoms, the inadequacy of previous examinations by a nonpsychiatric physician to rule out the possibility of physical disease causing psychiatric symptoms, and the patient's lack of awareness of current or pre-existing physical disease when consulting the psychiatrist. The following review examines nine categories of medical disorders that are known to produce psychiatric symptoms, with discussion of the psychiatric manifestations. Implications for current practice and training are briefly considered.